Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment
Background Very delayed aneurysmal rupture represents a rare, poorly understood, catastrophic complication of intracranial aneurysm flow diversion (FD) treatment. Case Description A 48-year-old woman presented to the neurosurgical clinic for an elective admission 6-month post-FD treatment...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
2017-10-01
|
| Series: | Indian Journal of Neurosurgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1607030 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850228801729986560 |
|---|---|
| author | Stylianos Pikis Tigran Petrosyan Eftychios Archontakis Georgios Arealis |
| author_facet | Stylianos Pikis Tigran Petrosyan Eftychios Archontakis Georgios Arealis |
| author_sort | Stylianos Pikis |
| collection | DOAJ |
| description | Background Very delayed aneurysmal rupture represents a rare, poorly understood, catastrophic complication of intracranial aneurysm flow diversion (FD) treatment.
Case Description A 48-year-old woman presented to the neurosurgical clinic for an elective admission 6-month post-FD treatment with a single pipeline embolization device (PED) treatment of a fusiform, large, midbasilar artery aneurysm. During her admission, the patient suffered a tonic-clonic seizure and collapsed. She was intubated and transferred for an urgent computed tomographic scan of the brain, which revealed subarachnoid hemorrhage and hydrocephalus. She was subsequently transferred to the operating room where an external ventricular drain was placed. Urgent diagnostic cerebral angiography revealed rupture of the previously treated aneurysm which was managed with deployment of a second PED and coil embolization of the right vertebral artery. Unfortunately, the patient succumbed to the disease 15 days later.
Conclusion The pathophysiologic mechanism responsible for delayed aneurysmal rupture post-FD treatment remains to be defined and may involve an acute rise in intra-aneurysmal pressures in a partially thrombosed aneurysm, continued hemodynamic stress on the aneurysmal wall due to persistent blood inflow, and thrombus-induced inflammation-mediated degradation the aneurysmal wall. Further clinical and anatomical studies are necessary to define the mechanisms responsible for delayed aneurysm ruptures and identify appropriate preventive measures. |
| format | Article |
| id | doaj-art-dc86952f171b40b9b5bb14256eb9af17 |
| institution | OA Journals |
| issn | 2277-954X 2277-9167 |
| language | English |
| publishDate | 2017-10-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Neurosurgery |
| spelling | doaj-art-dc86952f171b40b9b5bb14256eb9af172025-08-20T02:04:24ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Neurosurgery2277-954X2277-91672017-10-01070322723010.1055/s-0037-1607030Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion TreatmentStylianos Pikis0Tigran Petrosyan1Eftychios Archontakis2Georgios Arealis3Department of Neurosurgery, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, GreeceDepartment of Neurosurgery, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, GreeceDepartment of Interventional Neuroradiology, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, GreeceDepartment of Neurosurgery, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, GreeceBackground Very delayed aneurysmal rupture represents a rare, poorly understood, catastrophic complication of intracranial aneurysm flow diversion (FD) treatment. Case Description A 48-year-old woman presented to the neurosurgical clinic for an elective admission 6-month post-FD treatment with a single pipeline embolization device (PED) treatment of a fusiform, large, midbasilar artery aneurysm. During her admission, the patient suffered a tonic-clonic seizure and collapsed. She was intubated and transferred for an urgent computed tomographic scan of the brain, which revealed subarachnoid hemorrhage and hydrocephalus. She was subsequently transferred to the operating room where an external ventricular drain was placed. Urgent diagnostic cerebral angiography revealed rupture of the previously treated aneurysm which was managed with deployment of a second PED and coil embolization of the right vertebral artery. Unfortunately, the patient succumbed to the disease 15 days later. Conclusion The pathophysiologic mechanism responsible for delayed aneurysmal rupture post-FD treatment remains to be defined and may involve an acute rise in intra-aneurysmal pressures in a partially thrombosed aneurysm, continued hemodynamic stress on the aneurysmal wall due to persistent blood inflow, and thrombus-induced inflammation-mediated degradation the aneurysmal wall. Further clinical and anatomical studies are necessary to define the mechanisms responsible for delayed aneurysm ruptures and identify appropriate preventive measures.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1607030aneurysmruptureflow diverter |
| spellingShingle | Stylianos Pikis Tigran Petrosyan Eftychios Archontakis Georgios Arealis Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment Indian Journal of Neurosurgery aneurysm rupture flow diverter |
| title | Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment |
| title_full | Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment |
| title_fullStr | Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment |
| title_full_unstemmed | Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment |
| title_short | Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment |
| title_sort | fatal basilar aneurysm rupture 6 months following pipeline flow diversion treatment |
| topic | aneurysm rupture flow diverter |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1607030 |
| work_keys_str_mv | AT stylianospikis fatalbasilaraneurysmrupture6monthsfollowingpipelineflowdiversiontreatment AT tigranpetrosyan fatalbasilaraneurysmrupture6monthsfollowingpipelineflowdiversiontreatment AT eftychiosarchontakis fatalbasilaraneurysmrupture6monthsfollowingpipelineflowdiversiontreatment AT georgiosarealis fatalbasilaraneurysmrupture6monthsfollowingpipelineflowdiversiontreatment |